Background:
The Anticoagulation Safety Taskforce established a comprehensive Anticoagulation Safety Program over the last 2 years with the overall goal of reducing harm surrounding the use of the 3 most commonly used anticoagulants—heparin, warfarin, and enoxaparin—at our 5 hospital sites. This was accomplished through close collaboration and teamwork between nursing and medical leadership, pharmacy, quality improvement, administration, laboratory, and information technology. Because of well‐established safety issues with anticoagulants and the Joint Commission mandate in 2008, we used this opportunity to standardize policies, create evidence‐based protocols, build clinical decision‐making tools, create and implement electronic order sets that reflected best practice, determine outcome measures, and establish enhanced oversight of anticoagulant use at 5 hospital sites. Over the course of 2 years, this reflects part of the medical care routinely delivered to more than 5000 patients. Outcomes of this program include a significant decrease in alert values for warfarin and heparin, enhanced accuracy of enoxaparin dosing, and clear process improvements surrounding warfarin ordering. In addition, there is better compliance with a moderate‐ to high‐risk surgical subset receiving appropriate deep vein thrombosis prophylaxis.
Purpose:
To achieve greater depth with our program, we wanted to use daily inpatient data on warfarin, heparin, and enoxaparin orders to affect patient care in real time. This proactive approach is in contrast to the usual use of data that is trended retrospectively and then acted on for future care delivery.
Description:
A medical content expert and pharmacy resident collaborated as a team to formally round on high‐risk patients 3 times a week. These patients were identified by predetermined inclusion criteria that helped to target inpatients at the highest risk for bleeding or underdosing. The emphasis of these rounds was medication safety. During rounds, the team highlighted safety issues as needed to providers, provided real‐time education, modified medication orders, and distributed our anticoagulation pocket cards as warranted for future clinical decision support. This program was incorporated as a part of the pharmacy resident curriculum. The preintervention and intervention periods were each 6 weeks in duration. A total of 695 orders for heparin, 909 orders for enoxaparin, and 3753 orders for warfarin were reviewed during this 12‐week period.
Conclusions:
We have observed an early successful impact of anticoagulation safety rounds. The number of improper heparin orders decreased from 30% to 11%. The proportion of PTT > 110 has decreased from 11% to 6%. We have also seen order accuracy improve for both enoxaparin and warfarin. This program promotes the use of data to affect realtime patient care. In addition, there is enhanced collaboration between the medical staff and pharmacy to heighten awareness and outcomes surrounding the medication safety of anticoagulants.
Disclosures:
L. Sivaprasad ‐ none; R. Sussman ‐ none